You said that it's random when it twinges. That sounds very much like my experience of gout. The reason for randomness and also the fact that it comes as a sudden twinge is that the uric crystals of gout build up in the joint as a lump and cause restriction so that movement crushes the inner surfaces of the joint against the lump- that's the twinge! Then the crystals disperse and the next day I wonder what all the fuss was about, only to find it happens again later that day. I should say "happened", past tense, because I got it under control with several things:
By far the most important is hydration- especially in hot weather. I know that's obvious, but the number of times I've felt the twinge at the end of a hot afternoon of concentrated outdoor work and thought "oh dear, I've done it again- forgot to drink"- it must be twenty times. It took about five more times before that to notice the link.
Restrictive footwear that reduces toe movement even when walking. In my case it was steel toe-capped boots. They were very comfortable and well-fitting in every respect, except toe bendability. 2-3 hours in these was enough especially if I didn't keep hydrated.
It seemed to improve when I gave up dairy but I can't be sure.
It seems even better now that I've sort of given up wheat but I do have the odd crumpet and that doesn't cause a flair up.
On a couple of occasions, when I had an attack, I wiggled the relevant toe (not always affecting both) gently to disperse the crystals and stop them forming a lump. I only did this because I read that it was possible to affect the distribution and dispersal of the crystals this way. It seemed to calm down but it was only twice that I did it (the last two times I had an attack) and I can't say for sure it calmed because of that. However, because of the shoe restriction/toe movement issue, I think there is something in this. I wouldn't recommend it if is too painful because you might force the lump against the joint. Once it's formed you have to let it disperse on it's own through hydration and the other recommended dietary measures.
They say cut down on oily fish because purines stimulate uric acid formation. I'm sure that's the case but I'm eating plenty of sardines etc. and always have. I've mostly licked the gout problem (very small twinges once a month- always related to dehydration and/or restrictive footwear).
As a word of encouragement, for five years I couldn't kneel with my toes tucked under, at any time, attack or no attack. It was really painful to force the joint. But now I can with only a tiny bit of stiffness in the right toe and no pain.
Hope that helps you or anyone else.
